Healthcare Provider Details

I. General information

NPI: 1972261220
Provider Name (Legal Business Name): AASHKA SHAH PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/03/2021
Last Update Date: 11/28/2022
Certification Date: 11/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 W 14TH ST STE 1E40
WILMINGTON DE
19801-1013
US

IV. Provider business mailing address

501 W 14TH ST STE 1E40
WILMINGTON DE
19801-1013
US

V. Phone/Fax

Practice location:
  • Phone: 302-320-2100
  • Fax: 302-320-2121
Mailing address:
  • Phone: 302-320-2100
  • Fax: 302-320-2121

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA063275
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberC5-0011697
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: